nuchal fold measurements

[am678]

I went for my 12 week scan earlier this week and the consultant told me that the nuchal fold (?) looked quite big. The measurements she was getting went up to 3.2mm (although others were under 3) and she was very strong on the fact that it looked worrying to her. She scanned me again later in the week and it came out at 2.8mm

I haven't seen her in this or previous pregnancies but she seemed to be experienced. She has told me that in her view this means there is a high possibility something is wrong - and that in hundreds of pregnancies she had scanned where there were results of this level then the outcome was not good.

The line is very clear so maybe this is what was making her so adamant there was a problem? I've been looking on the internet and it seems to me that the risk is not as high as she is making it out to be and that even up to 3mm there is a good chance everything will be ok. I'm only 30. I am now waiting to get blood tests at 16 weeks. But again, she said that the blood tests didnt really tell you anything and not to be surprised if I came back as high risk. I'm willing to face up to the fact there may be something wrong but surely it is about level of risk rather than absolute certainties based on a scan?

i am sorry, but she is talking absolute nonsense. Where did you have your scan. On Monday you should call the "ARC" for reassurance - they have a telephone helpline for parents who are concerned by scan results. I have nf reading of 2.9mm at 12 weeks, and basically they said there is nothing to worry about - very low risk. Blood tests are an incredibly important factor when assessing risk - not just the nf measurement. Please try not to worry. I will look up the ARC phone number and post it in a minute. Also - check out the antenatal tests thread - lots of reassurance there too for you. xx

ARC details:

www.arc-uk.org

Helpline: 020 7631 0285 - Mon-Fri, 10am-5.30pm
Admin: 020 7631 0280 : Email: [email protected]

Hope they will help to put your mind at rest. xx

Thanks! I hadn't come across that and sounds really helpful. Will call them on Monday. x

There is a very good chance that everything will be ok, but equally - there is a chance that there may be something wrong.

You need to decide how important it is to you to find out for certain. Would you act on certain results or not? The only way you'll get a definite answer is by either having CVS now, or waiting until you're 16 weeks-ish for an amnio. x

Also, ARC are fantastic.

I'm surprised they have you waiting until 16 weeks for blood tests. Nuchal scanning is routine where I am booked. They take the measurements and a set of bloods on the SAME DAY (and I was told was vv important they were done on the same day). All of this put together then will give you a risk.

I think the bloods at 16 weeks are the older way of looking at Downs risk and don't take into account the nuchal thickness, though I might be wrong.

Other thing is are they happy with your dates as nuchal thickness is no use as a marker after 13+4

Hi just a quick note mine was 4.2mm and after lots of waiting for test results etc everything is all clear.
Where I live anything under 3mm is within the normal range, I spoke to ARC and they were brilliant.
I think it was really irresponsible of her to say she thinks there is a high chance of a problem if there was no other markers.
Hope its all ok.
Also I had the blood test at 12 weeks and the amnio at 16 weeks so maybe its worth checking she was right to have you waitng that long. Im 28 so near your age and got told the triple test was the most accurate way (bloods, age and nf)

Good luck.

am678 - wondered if you spoke to ARC?

Nuchal fold measurement is only one marker - the sonographer should also have looked at the nasal bone and a couple of other things. She should absolutely definitely have had a set of bloods to factor in as well - to give a calculated risk assessment. You should have had a number - 1 in 200 or 1 in 5 or whatever. In my area anything over 1 in 150 is considered low risk. Even 1 in 2 risk means only a 50% chance of a baby with Downs, and of course then you can choose (or not) to have CVS/amnio.

You can have a nuchal scan up to 13+6 - it may be worth going private to have it done if you can afford it. Where I live they have only just started offering nuchal scans on the NHS and it's clear they really don't know what they're doing. They scheduled mine too late on in the pregnancy and refused to move it any earlier (despite me pointing out that 15 weeks was TOO LATE for a nuchal) so I paid for a private scan last weekend. I got a proper consultant who specialises in this and nearly half an hour of scanning and explanation. It was absolutely worth it for the reassurance.

Octavia is describing best practice in nuchal screening but you don't get that level of detail on NHS nuchal scans. In fact I don't know why they bother with them.

The accuracy of the scan alone is only around 70% in detecting a problem, with bloods and the nasal bone detection it rises up to around 90%. The triple blood test alone is only around 70% too.

If you have time - get the full monty nuchal from a private clinic accredited to use the FMF software to calculate a more accurate risk assesment (Fetal Medicine Foundation.)

NHS seem to do different things everyhere! On the NHS I got nuchal fold, nasal bone and ductous venotus at the 12 week scan (i.e. nuchal fold measured, they checked for a nasal bone and the checked whether DV flow was normal or reverse) and double bloods taken on the same day... all on NHS. It is standard practice at my hospital.

OP - I think that 3mm is not especially high - I have heard of lots of mothers with good outcomes with similar (and higher!) measurements. the bloods and the other indicators (nasal bone and DV flow) are really important to give a full picture... How many weeks are you now? If you are still in the nuchal window, could you get the full test (i.e. scan with all markers plus bloods) done privately?

Sheesh - in NI there are NO hospitals that offer Nuchal fold testing never mind the others. If you want it you got to pay for it privately - the 1st tests you can get are the triple tests at 16 weeks (like seriously how many people act on bad results at 16 weeks - not as many I'm sure as would if they found out at 11 / 12 weeks!! or is that just me!)

So I'm having to pay privately for the Nuchal test & bloods £340!!! Ouch!! 2nd class citizens again!

BUT if you want CVS - no problem they'll do that on the NHS!!

Fizzie - its such a postcode lottery...

i'm sure some of mine were 2.8 the other week and my results came out at 1:1400 NHS 1:2300 private. How irresponsible and cruel of her to say something like that without giving you a proper risk assessment or giving you further courses of action beforE 16 weeks.

Wherabouts are you in the country? If near London I highly recomend a proper nuchal scan with bloods and all markers at the FMC if you are less that 13+6 - well worth £150. even if you are further along they will give you a much better assessmenet of risk.

Get a second opinion!

I just wanted to say thank you so much for the helpful advice and ARC were also really great. I hadn't realised that there was a combined test that needed to be done before a certain stage, and that this was different from taking blood at 16 weeks.

I wasn't even aware that the 12 week scan would look at the nuchal fold. The consultant said she had a duty to tell me the measurement but I had already signed to say I didn't want the 16 week screening bloods done as I have always felt I would rather not know. So in retrospect I am quite unhappy that she said anything, as it doesn't make any difference to what we would do (but gives us six months of worry).

I have booked in privately for a combined nuchal and blood scan on Thurs as it is not available on NHS in my area. This was a massive thing for me to do as going private is expense plus have to pay flights because of where I live, so it was really helpful to get encouragement to pursue that option. I know the results might confirm that there is a high risk but at least it will be based on statistics. I wouldnt have known about that option at all if I hadn't posted on here. Thanks again x

Good luck with everything - sorry it has been such a palava...

Terrible that you have to go to these lengths but I think it is worth doing, she has put that worry in hour head now and a proper assessment will put your mind at rest I hope. I am still amazed that they don't do the 12 week check properly in some areas, I really can't see the point of just measuring the nuchal fold and then doing nothing with it, even 6 y ago where I had my ds1 they gave you a risk factor based on nuchal, age and bloods and they noted the nasal bone. Make sure you show the proper private report to the doctor, put her to shame. Good luck.

I was told my DS's nuchal fold was high during my first pregnancy. Apparently it was routine at that hospital.

A whole lot of stress throughout the pregnancy, despite the fact that my second cousin told me her son's was wide too and he was fine. In the end, my DS was born perfectly normal. And his nasal bone was hard to spot in the first two scans too.

I do sympathise, really I do. Because if you have decided to keep the pregnancy - and already said you didn't want the extra screening (am that she felt it her 'duty ' in that case) then you do not need that hanging over your head for another six months.

Frankly, it was very unprofessional of her to tell you all that when you didn't want to know. I opted out this time (different HCT though) and my current pregnancy has been so much less stressful as a result.

Am678 - I am glad you are going to get some proper screening and some more helpful advice (but so sorry about the hassle and cost of it all). I really have been shocked recently about how patchy the NHS is about all of this. As I said above, I am v lucky in that my hospital is totally up to speed on all this and gives me everyting I would get on a full private scan (combined age, nuchal fold, nasal bone, DV flow and bloods) - the sonographers are from and train at the Fetal Medicine Centre on Harley St, so we are v spoilt...
BUT, other NHS trusts seem to be totally different - why can't we all have the same treatment? Why did am678 have to go through this stress and pay so much when its free/easy for others...?

I paid for a private combined nuchal fold and bloods test and had it at 13+3. My measurement was 3.1mm. The sonographer said it was slightly higher than average but still within limits. I'm 33 and the end ratio that they gave me was 1:9678 having taken into account bloods.

I don't think 2.8mm at 12 weeks is disasterous at all and seems to be well within the guidelines of the place I went to (there was a little graph showing upper and lower limits, average line and a dot where my measurement sat).

SoozleQ, it would be great to see that little graph for everyone's reassurance. I will try to browse internet maybe I will find something. I went for my first scan today and I am 13+5. The nuchal scan showed 2.7mm which I realise is on the higher side, but the nurse said nothing about it. On the other hand, she wrote gestational age was 14 weeks, so maybe the nuchal fold is not that relevant anymore. I have done blood test as well and now anxiously waiting for results..
Good luck for everyone and fingers crossed for healthy babies!

The nuchal fold scan is of questionable importance anyway - the blood tests are more persuasive. some consultants say there is no point in having the scan. I had a very low nuchal measurement (I think it was 1.3), so felt reassured, only to have the blood tests come back as high risk for downs anyway. I have since had an amnio which confirmed all is well. I really wouldn't get too stressed based on the scan alone - it is not that important, particularly if you are young enough that your general risk of downs is low anyway.